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In cases of alternating chills and fever, there are two main types of syndromes: one arises from the failure to resolve external pathogens; the other arises from excess Yang and deficiency of Yin. The former belongs to Exterior Syndromes (Biao Zheng), while the latter belongs to Interior Syndromes (Li Zheng). These must be distinguished and treated carefully without confusion.

1. When Cold Pathogens (Han Xie) stagnate and lodge in the meridians, causing alternating chills and fever, this resembles malaria but is not malaria. Although the treatment method should ideally involve releasing the exterior and dispersing pathogens, if the pathogenic factors remain for a long time, it is necessarily due to deficiency of Yuan Qi (Original Qi), where the healthy Qi cannot overcome the pathogenic Qi. Therefore, in treating such cases, the primary approach should be to simultaneously tonify Blood and Qi. If there is slight deficiency in the Blood aspect, and the physical constitution and Qi are not significantly weak, yet the pathogen remains unresolved, use San Chai Hu Yin (Three Bupleurum Decoction). If Fire is excessive and Blood is dry with persistent alternating chills and fever, use Yi Chai Hu Yin (One Bupleurum Decoction). If caused by fatigue or overwork, or if the constitution was originally weak, or if Liver and Spleen are insufficient, and the pathogen is not fully cleared, use Si Chai Hu Yin (Four Bupleurum Decoction), Wu Chai Hu Yin (Five Bupleurum Decoction), or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). If Yang pathogens have sunk into the Yin aspect, with slight internal heat and unresolved pathogen, use Bu Yin Yi Qi Jian (Decoction to Tonify Yin and Augment Qi). If Spleen and Stomach Yang Qi is not robust, and Middle Jiao Qi is not warm, with unresolved pathogen, use Wen Wei Yin (Warm the Stomach Decoction). If the disease has been prolonged leading to severe deficiency of Yuan Qi, with persistent chills and fever, one should solely focus on cultivating Yuan Qi without using dispersing methods; suitable formulas include Wu Fu Yin (Five Blessings Decoction), Gui Pi Tang (Restore the Spleen Decoction), Da Bu Yuan Jian (Greatly Tonify the Source Decoction), or Li Yin Jian (Regulate Yin Decoction). Observe the Yin and Yang conditions and select the appropriate treatment. If it is indeed Yang deficiency, warming and tonifying methods are indispensable.

2. Alternating chills and fever arising from Yin deficiency and Yang excess, or from simultaneous deficiency of both Yin and Yang, stem from insufficiency of True Yin (Zhen Yin) and generally belong to consumptive diseases. However, the degree of Yin and Yang deficiency or excess must also be distinguished. For instance, fever during the day and quietness at night indicates Yang pathogens flourishing in the Yin aspect, representing excess Yang. Quietness during the day and fever at night indicates Yang pathogens sinking into the Yin, representing deficiency of Yin. Cases where fever persists throughout the day and night, accompanied by irritability and profuse sweating, but which are not due to external contraction, although termed "Double Yang," are actually extreme Yin deficiency. Additionally, loose stools below or vomiting/nausea above, combined with tidal fever and night fever, indicate rootless Yuan Qi and belong to Yang deficiency diseases. Generally, for Yang Excess syndromes, one should purge the Yang, using bitter-cold herbs. For Yin Deficiency syndromes, one should tonify the Yin, using sweet-cool herbs. Only in the case of Yang deficiency, despite the presence of heat symptoms, cold and cooling methods are strictly contraindicated; this point is often unrecognized by many. However, when Yin deficiency causes heat, if Yin Qi is not exhausted, treatment is relatively easy; when Yang deficiency causes cold, if Yang Qi is not exhausted, treatment is also relatively easy. But if there is solitary Yang without Yin, neither cold nor hot treatments can be applied; if there is solitary Yin without Yang, neither hot nor cold treatments can be applied. This is referred to as a "double death" syndrome, for which there is no effective remedy. For Yin deficiency with Yang excess causing alternating chills and fever, or persistent night fever, use Jia Jian Yi Yin Jian (Modified One Yin Decoction). If Heart Meridian harbors heat, with Fire in the Yang aspect causing irritable alternating fever, use Er Yin Jian (Two Yin Decoction). If spontaneous night sweats persist with night fever, use Dang Gui Liu Huang Tang (Angelica Hexa-Huang Decoction). If Yin deficiency with Blood-Heat causes metrorrhagia and stranguria with night fever, use Bao Yin Jian (Preserve Yin Decoction). If Liver Fire is not cleared, leading to frequent depression and anger causing irritable fever, use Xi Xin Yin (Extinguish Fire Decoction). If women, prone to depression and anger, suffer from persistent alternating chills and fever, use Jia Wei Xiao Yao San (Modified Free and Easy Wanderer Powder). If the Three Yin channels are damaged, with Blood deficiency and Fire excess causing persistent irritable fever, use Di Huang Gao (Rehmannia Paste) or San Cai Feng Sui Dan (Three Talents Marrow-Sealing Pill). For men, women, and children, if Spleen and Stomach are injured, leading to Yang deficiency with floating Fire causing tidal fever and night fever, one must use Li Yin Jian, Wen Wei Yin, or Da Bu Yuan Jian to ensure preservation of life. Such cases are numerous, and the treatment principles are exquisite; do not dismiss them as eccentric theories.